Socioeconomic Factors and Abortive Outcomes of Clinical Pregnancy After Embryo Transfer in the Setting of Universal Health Insurance Coverage of IVF

Background@#In vitro fertilization-embryo transfer (IVF-ET), an expensive option for infertile couples, started to be fully covered by the National Health Insurance (NHI) from October 2017 in South Korea. We investigated the association between woman’s socioeconomic status (SES) and abortive outcomes in pregnancies after IVF-ET in the setting of universal coverage of the treatment. @*Methods@#Using the NHI database in South Korea, we conducted a retrospective cohort study of all women who achieved clinical pregnancy after ET between October 2017 and February 2019. A total of 44,038 clinical pregnancy episodes of 29,847 women who underwent ET were analyzed. We used employment status, income in percentiles, and living in the Seoul capital area as indicators of SES. Relative risks (RRs) for abortive pregnancy outcomes were calculated for each socioeconomic stratum, using log-binomial regression models included woman’s age, body mass index, fasting blood glucose, fresh ET, month of ET, and history of smoking. @*Results@#While most pregnancy outcomes were live births (n = 30,783, 69.9%), 11,215 (25.5%) cycles ended with abortion or early pregnancy loss, 1,779 (4.0%) cycles were ectopic pregnancy, 45 (0.1%) were coded as molar pregnancy, and 224 (0.5%) were fetal death in utero or stillbirth. The risk of overall abortive outcomes was higher when a woman was unemployed (adjusted RR, 1.08; 95% confidence interval [CI], 1.05–1.11) or living in a nonSeoul capital area (1.11; 95% CI, 1.08–1.14). The association between relative income level and abortive outcomes was close to null. Living outside Seoul capital area was associated with the greater risk of abortive outcomes especially in younger women. @*Conclusion@#Unemployment and living in non-capital areas were associated with a higher risk of abortive outcomes among pregnancies after ET, even in the setting of universal coverage of IVF-ET. This suggests potential impact of socioeconomic position on the IVF-ET pregnancy.

Position Statement: Exercise Guidelines for Osteoporosis Management and Fall Prevention in Osteoporosis Patients

Background@#The effectiveness of exercise for improving osteoporosis and fall prevention in patients diagnosed with osteoporosis or osteopenia has not been fully summarized. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology has developed exercise guidelines for patients with osteoporosis or osteopenia and provide evidence-based recommendations. @*Methods@#A systematic review identified randomized controlled trials (RCT) assessing the effect of resistance, impact, balance, aerobic training, and physical activity in osteoporosis and osteopenia on bone quality, physical performance, quality of life, and fall prevention. PubMed, Embase, KoreaMed, and RISS were searched from January 2000 to August 2022. Ten key questions were established to review the evidence and formulate recommendations. @*Results@#The 50 RCTs reported that even with osteoporosis and osteopenia, resistance and impact training consistently maximized bone strength, improved body strength and balance, and eventually reduced fall incidences. Resistance exercise combining 3 to 10 types of free weight and mechanical exercise of major muscle groups performed with an intensity of 50% to 85% 1-repetition maximum, 5 to 12 repetitions/set, 2 to 3 days/week, for 3 to 12 months is recommended. Impact exercises such as jumping chin-ups with drop landings and jump rope performed 50 jumps/session for at least 6 months with 3 or more days/week are recommended. @*Conclusions@#A multi-component exercise mainly comprised of resistance and impact exercise seems to be an effective strategy to attenuate the risk factors of osteoporosis and osteopenia. The integration of exercise guidelines and individualized exercise plans has significant potential to reduce the morbidity and mortality of osteoporosis.

Maternal Polycystic Ovary Syndrome and the Risk of Early Childhood Obesity in Female Offspring: A Nationwide Population-Based Study

Background@#To investigate the relationship between polycystic ovary syndrome (PCOS) in Korean women and childhood growth and obesity of their offspring. @*Methods@#This longitudinal case-control study using the Korean National Health Insurance claims database and the National Health Screening Program for Infants and Children database included women who delivered singletons between January 2007 and December 2008. Offspring’s body mass index (BMI) measurements taken between 42 and 80 months of age were compared according to a maternal history of PCOS. @*Results@#Among a total of 131,805 participants, 1,213 women had a history of PCOS and 130,592 women did not. Female offspring aged 66–80 months born to women with PCOS had significantly higher BMI than those born to women without PCOS; there was no significant difference in that of male offspring regardless of maternal PCOS. In the generalized estimating equation and multivariable logistic regression analyses, the female offspring born to women with PCOS had a significantly higher risk of obesity during the age of 42–54 and 66–80 months (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.09–2.21 and OR, 1.5; 95% CI, 1.05–2.15, respectively), than those born to women without PCOS, after adjusting for several confounding factors. @*Conclusion@#Maternal PCOS is independently associated with an increased incidence of childhood obesity in female offspring among Korean women. Women with PCOS should consider the risk of early childhood obesity in their daughters, even if they maintain a healthy weight themselves.

Machine Learning Approaches to Identify Factors Associated with Women's Vasomotor Symptoms Using General Hospital Data

Background@#To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. @*Methods@#Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. @*Results@#In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. @*Conclusion@#Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

Machine Learning Approaches to Identify Factors Associated with Women's Vasomotor Symptoms Using General Hospital Data

Background@#To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. @*Methods@#Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. @*Results@#In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. @*Conclusion@#Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

Association between vasomotor symptoms and sarcopenia assessed by L3 skeletal muscle index among Korean menopausal women

Objective@#To evaluate the association between vasomotor symptoms, skeletal muscle index, and sarcopenia in menopausal women. @*Methods@#This cross-sectional study included 295 Korean menopausal women aged 40–65 years who underwent abdominal computed tomography during routine health checkups between January 2014 and May 2016. The cross-sectional areas of adipose and skeletal muscles were measured at the L3 level using computed tomography. The skeletal muscle index is defined as the sum of the skeletal muscle area (cm2 )/height 2 (m2). Sarcopenia was identified by a skeletal muscle index of ＜ 34.9 cm2 /m2 . Vasomotor symptoms were assessed using the Menopause Rating Scale. @*Results@#The mean age of the participants was 54.93 ± 6.20 years. Vasomotor symptoms were reported in 160 women (54.2%). Sarcopenia was more prevalent in women without vasomotor symptoms (18.5%) than in those with (6.9%). Multivariate logistic regression showed that the prevalence of sarcopenia was inversely associated with the prevalence of vasomotor symptoms (odds ratio, 0.32; 95% confidence interval, 0.15–0.67). Moreover, the paraspinal muscle index was positively associated with the prevalence of vasomotor symptoms (odds ratio, 1.06; 95% confidence interval, 1.01–1.11) after adjusting for age, body mass index, waist circumference, adipose tissue area, history of hormone therapy, systolic and diastolic blood pressures, total cholesterol, insulin resistance, alcohol intake, and exercise. @*Conclusions@#Vasomotor symptoms are less common in women with sarcopenia than in those without, and are positively associated with paraspinal muscle mass in Korean menopausal women. Further longitudinal studies are required to investigate the causal relationships and underlying mechanisms.

Decision support system for the prognostication of sarcopenia in adult women: Machine learning analysis using Korean National Health and Nutrition Examination Survey data

Background@#We used machine learning and population-based data for analyzing the determinants of sarcopenia in adult women and developing its decision support systems for various subgroups. @*Methods@#All data was acquired from the Korea National Health and Nutrition Examination Survey, and women 18 years and older were included in this research. The variables were selected based on female characteristics and the ability to be acquired in a survey format, and were ranked by importance using Random Forest. From this ranking, four main variables were selected, age, menopause age, menarche age and number of pregnancy. A decision supporting system was constructed based on a tree randomly selected from Random Forest. @*Results@#We defined sarcopenia as -2SD below the appendicular skeletal mass (ASM) index reference of 0.5136, and 89.87% (n = 8,610) were found non-sarcopenic and 10.13% (n = 971) were found sarcopenic. The subjects were divided into 6 groups based on menopausal status and BMI. The obese postmenopausal women had the highest number of sarcopenia, whereas the non-obese premenopausal women had the least number of sarcopenic subjects. In non-obese premenopausal women, which was considered to be at the lowest risk for sarcopenia, the most determining variable was the menarche age, followed by age and number of pregnancies. In obese and postmenopausal women, which was considered to be at the highest risk for sarcopenia, the most influential factor was the menopausal age, followed by age and menarche age. @*Conclusions@#We identified the major determinants of sarcopenia using machine learning and population-based data. This study demonstrated the strengths of the random forest as an effective decision support system for each stratified subgroup to find its own optimal cut-off points for the major variables of sarcopenia.

Vasomotor Symptoms: More Than Temporary Menopausal Symptoms

Vasomotor symptoms (VMS), such as hot flashes and night sweating, are classic menopausal symptoms experienced by a majority of perimenopausal and postmenopausal women. VMS have received a great deal of attention due to their relationship with cardiometabolic risk. Further, accumulating evidence indicates that VMS are associated with an increased risk of several chronic diseases, including metabolic syndrome, type 2 diabetes mellitus, nonalcoholic fatty liver diseases, and osteoporosis in perimenopausal and postmenopausal women. These findings suggest VMS as biomarkers of impaired cardiometabolic conditions rather than just temporary symptoms in menopausal women, warranting further studies to confirm the casual relationship of VMS with these diseases and the exact underlying mechanism in this context.

Vasomotor Symptoms: More Than Temporary Menopausal Symptoms

Vasomotor symptoms (VMS), such as hot flashes and night sweating, are classic menopausal symptoms experienced by a majority of perimenopausal and postmenopausal women. VMS have received a great deal of attention due to their relationship with cardiometabolic risk. Further, accumulating evidence indicates that VMS are associated with an increased risk of several chronic diseases, including metabolic syndrome, type 2 diabetes mellitus, nonalcoholic fatty liver diseases, and osteoporosis in perimenopausal and postmenopausal women. These findings suggest VMS as biomarkers of impaired cardiometabolic conditions rather than just temporary symptoms in menopausal women, warranting further studies to confirm the casual relationship of VMS with these diseases and the exact underlying mechanism in this context.

Effects of Multicomponent Exercise on Cognitive Function in Elderly Korean Individuals

Background@#and Purpose: The aim of this study was to investigate the effects of multicomponent exercise on cognitive function, depression, and quality of life in elderly individuals. @*Methods@#This study prospectively recruited 605 participants, and constructed an exercise pyramid comprising even distributions of daily physical activities, aerobic exercise, musclestrengthening exercise, flexibility exercise, balance exercise, and activities that subjects could perform while sitting down. The exercise program was divided into six stages according to the participant’s level of frailty. The 12-week exercise program intervention was conducted once yearly. @*Results@#The exercise regimen was followed by 402 of the 605 enrolled participants, giving a dropout rate of 33.6%. The 27-month exercise program was completed by 60 participants.The scores for the Mini Mental State Examination for dementia screening (MMSE-DS), short form of the Geriatric Depression Scale, World Health Organization Quality of Life Assessment (WHOQOL-BREF), International Physical Activity Questionnaire (IPAQ), fear of falling, handgrip strength, and walking speed were improved after the exercise intervention. The analysis of frailty revealed that participants in the frail group showed greater improvements for the MMSE-DS, WHOQOL-BREF, IPAQ, fear of falling, handgrip strength, and walking speed. @*Conclusions@#Individually customized, multicomponent exercise programs lead to improved levels of cognitive function, depression, and quality of life, especially among those who are more frail.

Comparison of the Efficacy of Tibolone and Transdermal Estrogen in Treating Menopausal Symptoms in Postmenopausal Women

OBJECTIVES: This study aimed to compare the efficacy of tibolone and transdermal estrogen in treating menopausal symptoms in postmenopausal women with an intact uterus.METHODS: Overall, 26 women consumed tibolone orally and 31 women received transdermal estrogen gel mixed with progestogen. The menopause rating scale (MRS) was used to assess their menopausal symptoms at their first outpatient visit and 6 months later.RESULTS: The transdermal estrogen group showed significant improvements in more items of the MRS questionnaire. There was a favorable change in body weight in the transdermal estrogen group compared with that in the tibolone group. Depressive mood, irritability, physical and mental exhaustion, sexual and bladder problems, and joint and muscular discomfort improved only in the transdermal estrogen group, whereas heart discomfort and vaginal dryness improved only in the tibolone group. Nevertheless, the intergroup differences in each item were insignificant after adjusting for body mass index and hypertension, which differed before treatment.CONCLUSIONS: Both the therapeutic options improved menopausal symptoms within 6 months of use. However, transdermal estrogen appeared to be more effective in preventing weight gain in menopausal women than tibolone.

The Effect of Multi-tasking Exercise Intervention on Cognitive Function in Elderly and Cognitive Impairment Patients: a Pilot Multicenter Study

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the impact of multi-tasking exercise on cognitive and motor function in patients with mild cognitive impairment (MCI) and cognitive normal elderly (CNE).METHODS: A total of 144 subjects were recruited from 14 regional dementia centers in Busan Metropolitan City. With the exception of 77 subjects unsuitable for the study, 67 subjects participated in the intervention. The Korean version of Mini-Mental State Examination for Dementia Screening (MMSE-DS), Subject Memory Complain Questionnaire (SMCQ), and the Korean version of the Short-Form Geriatric Depression Scale (SGDS-K) were used to determine changes in cognitive function and depressive symptoms pre-post intervention in patients with MCI and CNE, respectively. To observe changes in motor function, 5-chair sit to stand and 5-meter walking speed on the lower body strength and walking ability were also measured in both groups.RESULTS: For the MCI group, changes in cognitive and depressive symptoms on the tasks of MMSE-DS (p=0.006), SMCQ (p=0.000), SGDS-K (p=0.000) and the result of the motor function analysis on the items of 5-chair sit to stand (p=0.000), normal speed (p=0.004) and maximal speed (p=0.002) of 5-meter walking speed (p< 0.005). In the CNE group, all the items except MMSE-DS (p=0.068) and SGDS-K (p=0.095) showed statistically significant improvement.CONCLUSIONS: Multi-tasking exercise intervention, including exercise and cognitive tasks, may possibly improve the cognitive and motor function in patients with MCI and CNE.

Effects of Autologous Platelet-Rich Plasma on Regeneration of Damaged Endometrium in Female Rats

PURPOSE: To investigate whether autologous platelet-rich plasma (PRP) treatment can improve regeneration of the endometrium in an experimental model of ethanol-induced damage. MATERIALS AND METHODS: Sixty female Sprague-Dawley rats were randomly assigned into three groups: control group, ethanol group, and PRP-treated group (administration of 0.25 mL of PRP into both uterine cavities 72 hours after ethanol injection). After 15 days of endometrial damage, all the animals were sacrificed during the estrous cycle, and samples were taken from the mid-uterine horn. Functional and structural recovery of the endometrium was analyzed by hematoxylin-eosin (H&E) and Masson trichrome (MT) staining, real-time polymerase chain reaction (PCR) assay, and immuno-histochemical (IHC) analyses. RESULTS: H&E and MT staining confirmed significantly decreased fibrosis and increased cellular proliferation in the PRP-treated group, compared to the ethanol group. The endometrial areas in the ethanol and PRP-treated groups were 212.83±15.84 µm² and 262.34±12.33 µm² (p=0.065). Significantly stronger IHC expression of cytokeratin, homeobox A10 (HOXA10), vascular endothelial growth factor (VEGF), and Ki-67 was found in the PRP-treated group, compared to the ethanol group. In real-time PCR analyses, interleukin-1β mRNA was down-regulated, while c-Kit mRNA was up-regulated, in the PRP-treated group, compared to the ethanol group. CONCLUSION: Intrauterine administration of autologous PRP stimulated and accelerated regeneration of the endometrium and also decreased fibrosis in a murine model of damaged endometrium.

THE EFFECT OF COMBINED EXERCISE TRAINING ON CAROTID ARTERY STRUCTURE AND FUNCTION, AND VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) IN OBESE OLDER WOMEN / 体力科学

The purpose of this study was to examine the influence of 12-week combined exercise program on carotid artery structure and function, and vascular endothelial growth factor (VEGF) in obese older women. All subjects were sixty years or older (66.90±4.2 years), performed the combined exercise training during 12-week consisting of aerobic exercise, band exercise, and yoga exercise for 70 minutes 3 times a week under the supervision of exercise specialist. Despite no statistically significant change in control group, percent body fat mass (3.26 %, p<.01), systolic blood pressure (6.2 mmHg, p<.05), diastolic blood pressure (5.6 mmHg, p<.001), and 10 m maximal walking time (0.56 sec, p<.05), TC (20.5 mg/dl, p<.05), and LDL-C (22.16 mg/dl, p<.05) were significantly decreased respectively after 12-week combined exercise in exercise group. In addition, sit-and-reach (3.6 cm, p<.01), oxygen uptake per weight (3.27 ml/kg/min, p<.05), VEGF (17.85 pg/dl, p<.001), and carotid artery LD (0.4 cm, p<.01), PFV (10.06 cm/sec, p<.05), EFV (6.04 cm/sec, p<.05) were significantly increased in the exercise group than in the control group. The VEGF had the significant correlation with LD (r=.389, p<.01), PFV (r=.427, p<.01), EFV (r=.264, p<.05). In conclusion, 12-week combined exercise program is effective to improve and/or physical function and body composition. And also, exercise can improve serum lipid metabolism, VEGF regulation, and carotid artery function and structure.

EFFECTS OF COMBLNED EXERCLSE ON β-AMYLOLD AND DHEAs IN ELDERLY WOMEN / 体力科学

The purpose of this study was to investigate the changes in health related fitness, β-amyloid and dehydroepiandrosterone sulfate (DHEAs) concentration, in elderly women after 12 weeks of combined exercise. Subjects consisted of fourteen elderly women (control : 7, exercise : 7) whose ages were over 75 yrs and mini mental status examination (MMSE) scores were more than 24. The combined exercise program included stretching for 10 minutes, 30 minutes of low impact aerobic exercise at an intensity above 40∼59% of HRR during 1∼6 weeks and 60∼84% of HRR during 7∼12 weeks, and 20 minutes of resistance exercise composed of muscle strengthening and posture correction. The program was conducted 3 times a week for 12 weeks. We found that peakVO₂ and peakVO₂/weight significantly (<i>P</i><.05) increased after combined exercise. Also β-amyloid significantly (<i>P</i><.05) decreased and DHEAs concentration significantly (<i>P</i><lated with a change in peakVO₂ (r=−0.929, <i>P</i>=0.001) and positively correlated with a change in LDL-C (r=0.799, <i>P</i>=0.031) in the exercise group. The change in DHEAs positively correlated with a change in peakVO₂ (r=0.705, <i>P</i>=0.017) in the exercise group. In conclusion, these results suggest that combined exercise in elderly women (mean age of 75-years) for 12 weeks would play a positive role in cardiopulmonary function, lipid metabolism and dementia risk factors such as β-amyloid and DHEAs.